NUR 4955 Postpartum

Reproductive System Changes

Involution of uterus escent of uterine fundus !ochia Cervi" #agina Perineum

!acerations

%hat &ould 'e an indication that your patient might have a cervical laceration( %hat manifestations might ma)e you thin) a'out the formation of a hematoma(

*our Patient

escri'es

+fterpains ,leeding

Ru'ra- serosa- al'a

Clots .emorrhoids Itching ,urning

,reasts

/ngorgement

,ottle feeding ,reast feeding

Nipple soreness

Positioning

0astitis

1vulation20enstruation

Resumption of ovulation and menstruation

345 &)s PP 6st cycle may 'y anovulatory delays7 return of ovulation and menstruation

,reastfeeding

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Cardiovascular System Changes

Cardiac output Plasma volume Coagulation ,lood values

Postpartum .emorrhage

8raditional definition

/,! 9 5:: ml after vaginal delivery /,! 9 6::: ml after C2S

+C1; <+merican College of 1,4;*N=

in .C8 of 6: pts from admission to PP Need for fluid replacement

*our Patient

escri'es

!ight headed upon standing ,leeding Night s&eats

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;astrointestinal System Changes

igestion

+ctive Common pro'lem

Constipation

Stool softeners

*our Patient

escri'es

>ear of having a 'o&el movement .unger Indigestion ;as ,ac) ache >la''y 'elly

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Urinary System Changes

+cetonuria Proteinuria !ost muscle tone in 'ladder 8raumati?ed meatus iminished sensitivity to fluid pressure iuresis 1ver4distended 'ladder

*our Patient

escri'es

>re@uency !oss of sensation ifficulty voiding ,urning ,lood in urine

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0usculos)eletal System Changes

0uscles and Aoints

0uscle fatigue Rela"in levels su'side .ip or Aoint pain ,ody mechanics and posture 8one and strength /"ercises iastasis recti

+'dominal &all

%eight !oss

+fter ,irth B Initial loss of 6:462 l's /arly Postpartum

Postpartum iuresis additional 5 l's

Return to pre4pregnancy &eight

345th &)s PP <if gain &as normal amount=

*our Patient

escri'es

>atigue 0uscle aches Coint pain >la''y 'elly No strength

Integumentary System Changes

Striae gravidarum Chloasma4 melasma !inea nigra .air loss Palmar erythema

26

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Neurologic System Changes

+nesthesia and2or analgesia ramifications Prevention of inAury

Safety issue 6D E&et tapF 5:D P P. 8reatment

Post dural puncture headache <P P.=

Conservative <'edrest- fluids- NS+I S- caffeine= 0ost resolve in 244 days ,lood patch <9:D effective- may 'e repeated=

*our Patient

escri'es
,ac) pain Num'ness 8ingling !oss of concentration

24

/ndocrine System Changes

Resumption of ovulation and menstruation

G49 &ee)s ,reastfeeding <not a contraceptive measure= Prolactin 1"ytocin 6:462 l' <during 'irth= +dditional 545 l' <early postpartum period=

!actation

%eight loss

Psychosocial System Changes

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Process of 0aternal +daptation

Puerperal phases

8a)ing4in <self= 8a)ing4hold <self and 'a'y participation= !etting4go <grieving process=

Ru'in <693G=

2G

Process of 0aternal +daptation

<contHd=

0aternal role attainment

53D of &omen &ith young children employed 9 4:D of pregnancies are unplanned

.eading to&ard a ne& normal Redefining roles Role conflict 0aAor maternal concerns

*our Patient

escri'es

0ild depression interspersed &ith happier feelings <'a'y 'lues=

Self4limiting /arly onset !asts no longer than 2 &)s 5:45:D of mothers oesnHt usually affect a'ility to care for infant

+nticipatory ;uidance

Nursing Care

#alidating feelings !a'eling it as real 'ut normal reaction Reassurance >amily Support 8each Partner

Promoting +ttachment

/arly- unlimited contact

Prolonged contact more touching 0ore time to learn ne&'ornHs needs

need to practice confidence praise I encouragement

+ssist parents to inspect the infant Place infant in an en face position Point out positive characteristics of infant

$6

8he Process of >amily +daptation

>ather Si'lings ;randparents

$2

Cultural Influences on +daptation

Provide care that is culture specific Communication

/JK donHt call attention to infantHs appearance- evil eye /JK no 'athing for the first $: days

.ealth 'eliefs

ietary practices

/JK no cool2cold foods- 'eer to enrich 'reast mil)

Postpartum Nursing +ssessment

, 4 ,reast U B Uterus , B ,ladder , B ,o&el ! B !ochia / B /pisiotomy2Incision . B .omanHs Sign / B /motional Status4PP 'lues

Postpartum Nursing Care C2S

>ocus assessments

,reathe Sounds ,o&el Sounds ressing >undus I !ochia /pidural site

+ctivity iet I#2>oley2 I I 1

;iving Report

/ach ;roup esigns a Patient +ge !0P ;28P+! +llergies 0ed2Surg ." 0edications Support system

8hen S&ap Patients andK Nursing diagnoses Interventions

Nursing Colla'orative

/"pected outcomes